PL 111-148 Policy Change Proposal Section II And III Research Proposals Example

Policy Change Proposal Section II

Section 2001 of PL 111-148 Change Objectives
The federal government shall pay 100% of the cost of the newly eligible individuals during 2015 and 2016
The federal government shall pay 100% in subsidies to individuals receiving Medicaid healthcare plans prior to the passing of this law
All Americans (individuals and families) with income below 133% of the federal poverty level will be eligible for Medicaid by the end of 2015

Policy Change Options

If section 2001 of PL 111-148 remains as is currently enacted, then its purpose in creating a new eligibility group (expand Medicaid) will partially fail because it will amount to swapping subsidies from citizens enrolled and receiving health insurance and prescription drugs to the previously ineligible group.
The incremental change may mean that the federal government pays between 90% and 100% of the cost for those receiving Medicaid healthcare plans prior to the ACA’s enactment in 2015 and/or 2016
The major change action will mean that the federal government pays 100% of the cost for the newly eligible population under section 2001 of PL 111-148 and those receiving Medicaid healthcare plans prior to the ACA’s enactment in 2015 and/or 2016

Definition of the financial criteria:

Substantive funding stream refers to the primary source of financing the proposed change in section 2001 on PL 111-148, including new funding streams by Congress, extension of existent programs, consumer rebates, and tax credits
Likelihood of ongoing funding refers to the probability or risk of the policy’s ability to raise adequate finances (federal and state) to meet the proposed or actual activities on a secured and unsecured basis at an acceptable price
Ability to meet current and future demands refer to the adequacy of the funding sources to finance the policy in the short-term and the needs of the changing position demographic and disease patterns
Political feasibility refers to the appropriateness, acceptability and responsiveness of the funding sources for relevant powerful stakeholders i.e. legislators, the public, insurance companies, decision makers, and care providers

Pros and Cons

The do nothing change option
Pros
It will avert further frustrations on the rising costs of implementing the ACA (Congressional Budget Office, 2015; Government Accountability Office, 2012)
It will save the Obama administration political capital to use in preventing hostile amendments by the GOP
It will save the ACA the amendment fatigue since more than 47 amendments have already been done by Congress (Walsh, 2015; Langer, 2014)
Cons
Relatively higher Medicaid cover costs for individuals receiving Medicaid healthcare plans prior to the enactment of the ACA
Medicaid expansion would be inequitable because its benefits would not be uniformly felt all the vulnerable populations
May result in increased demand for emergency care if the number of the uncovered population increases due to higher coverage costs without subsidies for individuals on Medicaid Advantage prior to the enactment of ACA

The incremental change option

Pros
It is a compromise that is more likely to be acceptable to both the supporters and opponents of the policy
Initial success due to incremental changes (piloting) can subdue resistance to the policy (Miller, 2014; Mason, Leavitt, & Chaffee, 2013)
It makes it possible to find any implementation difficulties and fix them before they escalate into major problems
Cons
If the policy is phased in, it may mean that the federal subsidies may not be applicable in 2015, and/or the cost of coverage would still be higher for the affected population prior to the full implementation

There’s little time for phasing in the changes since the changes are supposed to be effective from 2015 to 2016

Successive phases/expenditures may be affected by the ongoing legal/political factors including the 2016 presidential/Congressional elections
The major change option
Pros
Will deliver 100% subsidies to individuals Medicaid Advantage coverage to continue for those Americans that have been enrolled and received their prescription and healthcare insurance

Considerable public support for distributive justice and affordable healthcare (Langer, 2014; Wills & Kluwer, 2010)

Immediate high-end quality healthcare, coverage, and high doctor payouts if most of the vulnerable population in covered
Cons

Hostile reception by the GOP-controlled Senate and Congress will make passing the amendment bill difficult of delayed

Immediate increase in the cost of ACA
Opposition to all out changes would result in some states opting out or enacting hostile legislations to invalidate the amendment
Summary
Since the incremental change option is superior to the implementation of the proposed policy change option. While this option may fail to meet some of the current demands, it is preferred because of it is more likely to draw bi-partisan support (political feasibility) and would most likely receive adequate, current and future funding (Congressional Budget Office, 2015; Government Accountability Office, 2012). The major change option is easily the most desirable in meeting the current and future needs of the individuals on Medicaid Advantage prior to the enactment of the ACA, but it may struggle in securing current funding and as well as political support. This gives even more reason why the incremental change option is more suitable, because once it is fully implemented, it will be equal to the major change option.

Policy Change Proposal Section III

Recommendations
The PL 11-148 amendment proposal should be implemented using the incremental change option on the account of its bipartisan appeal, ease of securing adequate funding, ability to fully meet future demands and the possibility of fixing implementation hiccups in the interim
The PL 111-148 amendment should be made out as a redistributive justice policy change to facilitate stakeholder buy-in, separate from the wider legal and political issues facing the ACA since it will make the ACA more equitable if the law remains, but may be repealed along with the ACA if the legal and political challenges succeed
It is important to secure state support to lessen opposition to the individual mandate, bolster risk pooling and prevent perceptions of the federal government usurping the state and local rights over health and social policy

References

Congressional Budget Office. (2015). The Budget and Economic Outlook: 2015 to 2025. Washington, DC: Congressional Budget Office.
Government Accountability Office. (2012). The Federal Government’s Long-Term Fiscal Outlook. Washington, DC: GAO.
Langer, G. (2014, March 17). At 49 Percent Support, Obamacare Hits a High. Retrieved Feb 15, 2015, from http://abcnews.go.com/blogs/politics/2014/03/at-49-percent-support-obamacare-hits-a-high/
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare - Revised Reprint. New York: Elsevier Health Sciences.
Mehta, J., & Mehta, J. (2012). How the Patient Protection and Affordable Care Act (PPACA) SupportsFederalism. J Forensic Res 3, e107.
Miller, T. P. (2014, Dec 23). Repeal, replace, or revise? The choices ahead for Obamacare critics. Retrieved Feb 25, 2015, from https://www.aei.org/publication/repeal-replace-revise-choices-ahead-obamacare-critics/
The Staff of the Washington Post. (2010). Landmark: America's new health-care law and what it means for us. New York, NY: Public Affairs.
Walsh, D. (2015, Feb 4). House votes - again - to repeal Obamacare. Retrieved Feb 15, 2015, from http://edition.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/
Wills, E., & Kluwer, W. (2010). Theoretical Basis for Nursing 3rd. ed. . New York: Lippincott Williams and Wilkins.